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The Bonny Method of Guided Imagery and Music (hereafter BMGIM) is one method among various forms of music psychotherapy. It differs from other music therapy methods in that there is a prescribed format for the session and there are specific music programs that the BMGIM therapist uses. BMGIM has been described in many publications (Bonny 2002; Clark 2002; Erdonmez Grocke 2001; Goldberg 1995) and only the outline of BMGIM will be presented here.

The BMGIM session comprises four segments:

1. The ‘prelude’ or preliminary discussion. The client discusses any issues or concerns and together with the therapist decides on the main issue to be explored in the session (for example, personal issues, relationship difficulties or issues relating to clinical pathology).

2. The induction. The client lies down on a relaxation mat (or comfort-able chair), with eyes closed, and the therapist provides a relaxation induction that is individually tailored to the client’s level of energy, and to the main issue for the session. At the end of the relaxation induction the therapist provides a focus image, which is also related to the issue of the session.

3. The music and imagery segment, in which the BMGIM therapist chooses the music program of approximately 30–45 minutes duration.

As the music plays, the client’s experiences and images are relayed verbally to the therapist. The therapist asks questions (interventions) which are designed to bring the client closer to the imagery and to

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encourage the client to notice any feelings or emotions that are associ-ated with the image. The therapist also takes a written transcript of the imagery sequence.

4. At the end of the music the therapist helps the client bring the imagery to a close, and the client is re-orientated to a non-altered state of con-sciousness. The client is encouraged to make connections between the imagery in its symbolic form in relation to daily life issues. This pro-cessing is done through verbal discussion, free drawing, mandala drawings or sculpting with clay.

Clients have a range of experiences in BMGIM, as we see in Table 5.1, that are associated with a rich variety of imagery.

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Table 5.1 Categories of experience in BMGIM

Visual experiences Colours, shapes, fragments of scenes, complete scenes, figures, people, animals, birds, water (lakes, streams, oceans, or pools) Memories: childhood

memories Memories of significant events, significant people, and feelings in the client’s life are explored through reminiscences

Emotions and

feelings The full gamut of possible feelings like sadness, happiness, joy, sorrow, fear, anger, and surprise

Body sensations Parts of the body may feel lighter, or heavier; parts of the body may become numb and feel split off from the body; there may be feelings of floating or falling; sensations of spinning, or feelings that the body is changing in some way

Body movements The client may make expressive movements of the body in relation to the imagery being experienced, e.g. hands create a shape, arms reach up in response to an image, fists or legs pound on the mat in reaction to feelings of anger

Somatic imagery Changes within the internal organs of the body may be experienced, e.g. pain felt in the chest or heart, exploring an internal organ for its shape and colour, a surge of energy felt through the entire body

Altered auditory

experiences There may be an altered auditory perception of the music: the music comes from far away; the music is very close; one particular instrument stands out (which can also be transference to music)

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The BMGIM music programs

Each of the music programs (of 30–40 minutes) incorporates selections from the Western classical music repertoire. A movement of a larger work may be pro-grammed alongside a work of another composer or another stylistic period.

Each music program is designed to have a beginning piece that stimulates imagery, a middle selection to deepen the experience emotionally and a final selection that returns the client to a normal emotional state. Bonny designed 18

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Associations with the music and

transference to the music

Memories of when the music was heard last, memories of playing the music; the music is being played especially for the person; the person is actually playing the music being heard

Abstract imagery Mists, fog, geometrical shapes, clouds, etc

Spiritual experiences Being drawn toward a light; a spiritual person: a monk, priest, woman in flowing robes; being in a cathedral; feeling a presence very close

Transpersonal

experiences The body becoming smaller, or larger, change felt deep in the body (cells changing, parts of body changing shape)

Archetypal figures from legendary stories may appear

King Arthur, Robin Hood, the Vikings, Aboriginal man/woman, a witch, Merlin, etc

Dialogue Significant figures from the client’s life may appear in the imagery and often have a message, so that dialogue may occur, e.g. with parental figures; aspects of self may be symbolised in human form (a baby or adult figure), or significant companions (e.g. an albatross or an eagle) and dialogue may occur with these aspects

Aspects of the shadow or anima or animus

Aspects of the shadow frequently appear in the image of a person of the same gender, aspects of the anima/animus in images of a person of the opposite gender

Symbolic shapes and

images A long tunnel, a black hole, seed opening: these shapes or images can be symbolic of moments of change or transition; symbolic images such as an ancient book or the trident shape often have specific meaning to the client

Source: Erdonmez Grocke (2001/1999) Table 5.1 continued

music programs but currently there are 66 in use (Bruscia and Grocke 2002, pp.555–591) developed by other BMGIM therapists.

The BMGIM therapist chooses the music program for the client based on the issue for exploration, the mood of the client and level of physical and emotional energy on the day. The therapist, therefore, needs to know the music programs inti-mately. The Bonny programs are grouped according to the relative needs of the client and also the client’s experience of BMGIM as a therapeutic method. Some programs are considered ‘diagnostic programs’. This means that they are fre-quently chosen for the client’s first session, to encourage the client to engage imagery, and also for the therapist to make an assessment about the client’s ability to use the method productively as therapy.

Following the initial assessment session, the therapist may subsequently choose music programs referred to as ‘working programs’. This term implies that the music is more demanding in mood and intensity.

A third group of programs may be used for clients who have experienced BMGIM over many sessions. They are able to use strong music to enhance their experiences, while maintaining the ability to close the imagery at the end of the music and return to a non-altered state of consciousness.

A fourth type of program has been devised for specific emotional needs: for example, Grieving (devised by Linda Keiser Mardis) and Affect Release, pro-grammed by Bonny, which comprises music for the release of anger and other strong emotions, such as triumph and celebration (Bruscia and Grocke 2002).

Choosing a music program for a session

The therapist chooses a music program either to match the mood of the client or to match the issue that the client talks about during the discussion segment of the session. Sometimes the therapist may change the music program if it does not support the client’s imagery experience, on other occasions the therapist might spontaneously program all of the music selections.

The mandala

In the integration phase of the BMGIM session the client is encouraged to draw a mandala. The mandala is a circle shape that is ‘an archetypal symbol representing wholeness’ (Bush 1992). In discussing the meaning of the mandala, the therapist and client consider the colours, shapes and forms that might be symbolic of the images that emerged during the music.

The BMGIM therapist may note whether the client’s drawing is within the circle, or extends beyond it, and how much of the circle is filled with images. In

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viewing the mandala the therapist generally draws on the theories of Kellogg (1978), an art therapist who worked with Helen Bonny at the Baltimore Psychi-atric Centre (Clark 2002).

Overview of types of case studies in BMGIM

When writing a case study in BMGIM, the therapist/author is faced with a large amount of material that must be organised and reduced into some structure for publication. Data from BMGIM sessions comprise:

· the therapist’s notes taken during the preliminary discussion, which may include details of the client’s dreams

· the choice of music program and salient features of the music selec-tions

· the written transcript of the music and imagery session including the client’s imagery, feelings, dialogue, and other experiences

· a sketch of the drawn mandala, and interpretations of meaning

· the therapist’s reflections, written after the client has left the session.

The biggest challenge in writing a BMGIM case study therefore is not what to put in to the case study, but what to leave out.

There are various kinds of case studies in BMGIM:

· the individual case study

· collective case study

· negative case study

· heuristic case study.

The individual case study

Much of the early research in BMGIM came from single (individual) case studies.

In advanced level training (level 3), the Association for Music and Imagery (AMI) in the USA requires a case study of a minimum ten sessions in BMGIM. Many of these case studies are published in the Journal of AMI and are written from the author/therapist’s perspective. The author/therapist must organise the infor-mation to show the client’s development through an analysis of key images, symbolic changes in key images, or in recurring patterns of imagery sequences, or through transformation of imagery or emotional responses.

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The typical structure of an individual case study in BMGIM is:

· background of the client’s history and presenting issues

· goals for the series of BMGIM therapy

· synopsis of the sessions identifying choice of music, key imagery and mandala

· interpretation of the symbolic and metaphoric meaning of the imagery and mandala

· outcomes of the therapy in relation to the client’s issues or goals.

An example of an individual case study in BMGIM that traces changes in key images is Pickett’s (1992) case study of a woman with multiple addictions (an eating disorder and addiction to prescribed medication). Pickett traced key images (the wall, the addict, the talking loaf of bread and the dead tree) that related to the client’s therapeutic process. She identified various parts of the client’s personality which emerged during the therapy, and concluded that the client was better able to

‘directly confront her feelings’ (p.66). This impacted positively on the client’s ability to develop meaningful social relationships, which had been one of the goals of therapy.

Individual case studies also draw on interpretations from theories allied to BMGIM, including the theories of Jung and Gestalt. For example, in Borling’s (1992) study of a woman survivor of childhood abuse, he provides a summary of the 17 sessions given to the client, identifying physical, embodied responses as the most common experiences of the client. Borling then discusses the outcomes of the therapy from three different frameworks: Bradshaw’s Inner Child, Grof ’s Basic Perinatal Matrices and Kellogg’s Mari Card Test. He found that when he placed the client’s progress in BMGIM alongside the three frameworks, it confirmed that she was at the same point on each of the three paradigms.

Jungian archetypes appeared in Erdonmez’ (1995) case study of five BMGIM sessions with a woman in the terminal stages of motor neurone disease. The arche-typal images included a wise old man, a wise woman in the image of a crone and other significant images of transition (the snake and the tortoise).

Collective case studies

The collective case study describes several clients who have an aspect of common need, where the commonalities between the clients are noted and identified.

An example of a collective case study is Clark’s (1995) study of four clients, in which she traced the similarities between the clients as applied to the Hero’s Journey (Campbell 1968). The stages of the Hero’s Journey typically include: the

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call to adventure; meeting supernatural aid; crossing the threshold of adventure;

trials and tasks; reaching the nadir; receiving the boon (prize); the return and crossing of the return threshold. Clark illustrates each of these stages through the imagery of the four clients.

Bruscia’s (1992) collective study of 20 men diagnosed with the AIDS virus, categorised the clients’ experiences over a total 250 sessions. He found that for each client the healing process began with visits from the other side – that is, a visi-tation within the imagery of a significant person who was deceased. The experi-ences commonly found in BMGIM sessions of gay men carrying the AIDS virus included ‘getting out of limbo’, healing relationships, finding forgiveness, putting anger aside and embracing life and death.

Negative case study

It is unusual in music therapy to find a case study that describes the therapeutic intervention as contraindicated. Clarkson (1994), however, described the diffi-culties she encountered when using BMGIM with a client in a hypomanic episode, where BMGIM tended to aggravate the client’s confusion. Negative case studies are important in building a knowledge base of conditions and disorders that are contraindicated.

Heuristic case studies

Most case studies in BMGIM are written by the therapist, who inevitably imposes a biased view on the outcome of therapy. Heuristic case studies allow the client to describe their experience, thereby providing an unbiased account of the relative value of the therapy. Several heuristic case studies of BMGIM appear in Hibben’s Inside Music Therapy (1999). Authors have used narrative to describe their expe-rience from their own perspective (Buell 1999; Caughman 1999; Isenberg-Grzeda 1999; Newell 1999; Schulberg 1999).

Challenges in writing a case study in BMGIM

One approach to writing a case study in BMGIM is to organise the session infor-mation into themes, or phases of therapy. Decisions have to be made about how much of the imagery is included, how much information to give about the music chosen for the sessions, and how many of the mandalas are reproduced in order to provide the necessary flow to the writing of the case study.

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In the case study that follows, there were a number of issues that required decisions:

· The case material was spread over 56 BMGIM sessions. It was impos-sible therefore to include information on each and every session.

· The client, a graduate in English literature, had imagery that was satu-rated in meaning and significance, and only some interpretations could be included.

· The client worked through an impressive number of issues in her life, and these were grouped into four phases of therapy.

· The client drew many mandalas – sometimes two to three in each session, as well as five to seven during the week between sessions.

Only a few mandalas are reproduced in the case study.

As therapist I chose music selections that resonated with the different personalities that appeared in the client’s therapy work, and I often chose the music in order for a specific personality to be brought forth.

Case study: Samantha Background history

At the time of referral, Samantha was 36 years old. She had referred herself for therapy following a weekend workshop on ‘Music Without Stress’, during which the author had spoken about music therapy approaches in the treatment of performer anxiety. Several music therapy methods were described, including the Bonny Method of Guided Imagery and Music (BMGIM). Samantha had performed on the piano during the weekend workshop showing a high level of anxiety. She commenced therapy with the author one week after the workshop weekend.

Samantha was born in a country town and described her childhood as a time of confusion. She recalled instances of physical and emotional abuse by both parents. Her father brought into the family unit an explosive, uncontrolled aggression. Her mother was also physically and emotionally abusive to the children, frequently strapping them and shouting at them. As a young woman Samantha had gained a Bachelor of Arts degree, majoring in English literature and languages.

She has one sister who is two years younger and she described their rela-tionship as close, claiming that her sister knew her better than herself. Samantha

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had worked as a high school teacher and then set up her own practice as a piano teacher. She was married but, by choice, had no children.

At the start of therapy, Samantha identified difficulties with performer anxiety in that she often could not remember details of her piano performances, and felt very anxious before, during and after performances. These symptoms are con-sistent with a ‘dissociative’ reaction concon-sistent with a childhood marred by physical and emotional abuse (DSM-IV).

Samantha had good insight into her problems, and was highly intelligent. She also had a delightful sense of humour and enjoyed playing on words.

Initial assessment

At the first session she mentioned that she would be sitting an advanced level piano examination in two weeks time. It seemed contraindicated to commence therapy work until after the examination and I mentioned to her in the first session that she might like to purchase mandala materials and express her feelings and anxieties over the next two weeks through drawing. I explained that a circle should be drawn in the centre of the page as a reference point, and the drawing could be contained within the circle, or extend beyond it.

The second session occurred after the piano examination, which Samantha described as a disaster. She had argued with the examiner and had little memory of her playing. She was very anxious about how she would face her friends and piano students (and their parents) if she failed. She had drawn seven mandalas during the week, and the last of these depicted death (Figure 5.1).

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Figure 5.1

Session 3, following the examination was the assessment session. I considered several options for Samantha, and decided on a short three-minute piece of music to see how she might work with imagery. The music was ‘Lullaby’ from James Galway’s ‘Songs from the Seashore’. Samantha was seated in a comfortable chair, and a short relaxation induction was given focusing on her breathing, followed by the focus image of a scene by the seaside.

Immediately Samantha pictured an albatross. Her eyes flickered open and stayed open for the remainder of the imagery. The albatross had a child on its back, and they were flying out to sea. There was a girl on the edge of the cliff, waving goodbye to them. The albatross was white with black tips on the wings, and the child on its back felt wonderful, and free. The girl on the cliff felt sad – she wanted the bird and the child to come back, but she knew they wouldn’t.

Immediately Samantha pictured an albatross. Her eyes flickered open and stayed open for the remainder of the imagery. The albatross had a child on its back, and they were flying out to sea. There was a girl on the edge of the cliff, waving goodbye to them. The albatross was white with black tips on the wings, and the child on its back felt wonderful, and free. The girl on the cliff felt sad – she wanted the bird and the child to come back, but she knew they wouldn’t.